<%@ page language="java" contentType="text/html; charset=UTF-8"
    pageEncoding="UTF-8"%>
<%@ taglib prefix="c" uri="http://java.sun.com/jsp/jstl/core"%>
<c:set var="ctx" value="${pageContext.request.contextPath}" />
<% String appPath = request.getContextPath();%>  
<!DOCTYPE html>
<html>
  <head>
    <title>预约登记</title>
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <!-- Bootstrap -->
    <link rel="stylesheet" href="http://cdn.bootcss.com/twitter-bootstrap/3.0.3/css/bootstrap.min.css">
	
	<style type="text/css">
		body{font-family:"ff-tisa-web-pro-1","ff-tisa-web-pro-2","Lucida Grande","Helvetica Neue",Helvetica,Arial,"Hiragino Sans GB","Hiragino Sans GB W3","WenQuanYi Micro Hei",sans-serif;}
h1, .h1, h2, .h2, h3, .h3, h4, .h4, .lead {font-family:"ff-tisa-web-pro-1","ff-tisa-web-pro-2","Lucida Grande","Helvetica Neue",Helvetica,Arial,"Hiragino Sans GB","Hiragino Sans GB W3","Microsoft YaHei UI","Microsoft YaHei","WenQuanYi Micro Hei",sans-serif;}
	
	</style>
    <!-- HTML5 Shim and Respond.js IE8 support of HTML5 elements and media queries -->
    <!-- WARNING: Respond.js doesn't work if you view the page via file:// -->
    <!--[if lt IE 9]>
        <script src="http://cdn.bootcss.com/html5shiv/3.7.0/html5shiv.min.js"></script>
        <script src="http://cdn.bootcss.com/respond.js/1.3.0/respond.min.js"></script>
    <![endif]-->
  </head>
  <body>
	
<div class="container">
<br>
<form id="step3form" class="form-horizontal" action="${ctx}/web/orderStep4" method="post">
	<div class="form-group">
	    <label for="NAME" class="col-xs-4 col-sm-2 control-label text-right">症状描述：</label>
	    <div class="col-xs-8 col-sm-10">
	     <input name="NAME" type="text" class="form-control" placeholder="症状描述" required>
	    </div>
   </div>
   <div class="form-group">
	    <label for="CARDID" class="col-xs-4 col-sm-2 control-label text-right">部位：</label>
	    <div class="col-xs-8 col-sm-10">
	     <input name="CARDID" type="text" class="form-control"  placeholder="部位">
	    </div>
   </div>
   <div class="form-group">
	    <label for="SEX" class="col-xs-4 col-sm-2 control-label text-right">患病时间：</label>
	    <div class="col-xs-8 col-sm-10">
	     <input name="SEX" type="text" class="form-control"  placeholder="患病时间" required>
	    </div>
   </div>
   <div class="form-group">
	    <label for="PHONE" class="col-xs-4 col-sm-2 control-label text-right">已做检查：</label>
	    <div class="col-xs-8 col-sm-10">
	     <input name="PHONE" type="text" class="form-control"  placeholder="已做检查" required>
	    </div>
   </div>
<div class="row">
  
  <div class="text-center col-xs-12 col-sm-12"><button id="sbtn" type="submit" class="btn btn-primary col-xs-12 col-sm-12">预约</button></div>
  <!-- Optional: clear the XS cols if their content doesn't match in height -->
  <div class="clearfix visible-xs"></div>
</div>


</form>
</div>

<!-- jQuery (necessary for Bootstrap's JavaScript plugins) -->
<script src="http://cdn.bootcss.com/jquery/1.10.2/jquery.min.js"></script>
<!-- Include all compiled plugins (below), or include individual files as needed -->
<script src="http://cdn.bootcss.com/twitter-bootstrap/3.0.3/js/bootstrap.min.js"></script>

<script type="text/javascript">

</script>
  </body>
</html>